The Institute of Medicine recommendations on vitamin D are a new low in ignorance and data suppression.

--

By Marc Sorenson, EdD

The Institute of Medicine (IOM), a health arm of the National Academy of Sciences, has just released its long-awaited vitamin D supplementation recommendations. To the disappointment of the world’s leading vitamin D scientists, those recommendations make a mockery of an exhaustive body of scientific research.

The IOM suggests that 600 international units (IU) of supplemented vitamin D3 per day is ideal, and that a blood level of 20 ng/ml is sufficient for optimal human health. The IOM also suggests that supplementation with higher quantities of vitamin D could be harmful and that there are no randomized controlled trials to prove the safety or efficacy of higher levels of supplementation.

The Sunlight Institute declares that the IOM’s recommendations are ill-conceived and dangerous for the following seven reasons:

1. Extensive research indicates that if there were no other dietary source of vitamin D, 600 IU per day in adults would produce a blood level, on average, of about 6 ng/ml, a level so low that it correlates to the occurrence of the disease osteomalacia or “adult rickets.” Incredibly, in the press conference, it was stated that 600 IU would be adequate at the North and South Poles.

2. The IOM considers the 600-IU-per-day recommendation, added to dietary sources and sunlight exposure, to be sufficient for optimal health. In reality, little vitamin D is present in foods. For example, three glasses of vitamin D-fortified milk provides only 300 IU; 3.5 oz. of farmed salmon, 200 IU; a glass of fortified orange juice, 100 IU totaling a mere 1,200 IU per day including the IOM-recommended 600 IU supplement. Sunlight exposure, the most natural and productive source of vitamin D, could easily fill in the gap to a 2,000 IU level during the summer, but in the winter, north of latitude 340,(On a line from Los Angeles to Atlanta, for example) little or no vitamin D is produced. In the northern US and in Canada, “vitamin D winter” (the time during which the body cannot produce any vitamin D from the reduced amount of available sunshine) lasts for several months. Ninety-five percent of Canadians are considered (by non-IOM measures) to be D deficient in winter, and Americans in the Northern states are not much better. A 600-IU supplement plus the IOM’s recommended food sources is a recipe for a winter health disaster, which may include highly increased susceptibility to colds, influenza, cancer, heart disease MS, septicemia and numerous other maladies. It was also stated at the IOM press conference that the average American gets 200-300 IU from food.

3. Vitamin D blood level of 20 ng/ml are not really even sufficient for bone health, and that number sets research back several years. The “normal vitamin D range” printed on laboratory blood-test results prior to 2005 was from 8.9 ng/ml to 46.7 ng/ml. Based on newer research findings, that range changed after 2005, and lab test results began carrying the statement, “Recent studies consider the lower limit of 32 ng/ml to be a threshold for optimal health” with a reference to research conducted by Dr. Bruce Hollis who is widely regarded as one of the world’s top vitamin D scientists. (Hollis BW. J Nutr 2005;135:317-22) Dr. Hollis stated: “The current adult recommendations for vitamin D, 200-600 IU per day, are very inadequate when one considers that a 10-15 min whole-body exposure to peak summer sun will generate and release up to 20,000 IU vitamin D-3 into the circulation.” Hollis has also established that pregnant and lactating women need as much as 6,000 IU daily to provide for their own and their infants’ needs (Hollis, BW. J Bone Miner Res 2007;22, suppl 2:V39-44). The IOM’s low recommendations attempt to take us back to the Dark Ages of vitamin D knowledge.

4. The fact that up to 20,000 IU of vitamin D can be produced by sunlight exposure (the natural source of vitamin D) defines the IOM recommendation of 600 IU as being ludicrous. 600 IU is produced in summer sunlight in less than one minute in a light skinned individual. If God or nature created a system that produces such a vast quantity of D, there is a reason for it, and it is obvious that 5,000 IU per day is not harmful. Dr. Reinhold Vieth has presented compelling information that there is no evidence of any toxicity or adverse effects at prolonged intakes of 10,000 IU per day (Vieth, R Ann Epidemiol;2009;19:441-5).

5. The IOM also inexplicably recommended the same vitamin D intake for infants as for adults (600 IU), which to any reasonable person, is illogical.

6. The IOM used only bone health to make its recommendations, but bone health is a terrible indicator of adequate vitamin D levels because only very small quantities of vitamin D are adequate to ensure bone health. The IOM, by ignoring both observational and randomized controlled trials showing that low levels of vitamin D correlate to a multitude of health problems including cancer, heart disease, depression, influenza, Multiple Sclerosis, and autism, has done a dreadful disservice to those struggling with these and other health issues that are impacted by low vitamin D levels.

7. Ironically, the IOM consulted with several leading vitamin D researchers but then completely ignored their recommendations. This indicates a bias that may extend beyond simple ignorance and descend into the realm of concealing information.

Another of the most prolific researchers in the vitamin D field, Dr. William Grant, gave the Sunlight Institute this statement regarding his feelings about the IOM report:

“The Dietary Reference Intakes for Vitamin D and Calcium committee of the Institute of Medicine of the National Academies was essentially a tool of the agencies that funded the study, including the Food and Drug Administration and the National Institutes of Health. Federal sponsors defined the key questions, and a technical expert panel was assembled to refine the questions and establish inclusion and exclusion criteria for the studies to be reviewed. By excluding ecological studies and case-control studies in which serum 25(OH)D levels were measured at time of diagnosis, they in essence dictated the conclusion that vitamin D has no health benefits other than for healthy bones. Since 90% of our vitamin D comes from the sun, they throw out 90% of the evidence. The work of this committee contrasts with well-conducted scientific reviews such as that by the Intergovernmental Panel on Climate Change, which included over 600 scientists contributing to the report and 500 scientists as reviewers. The process was open rather than behind closed doors and resulted in a Nobel Prize for the contributors. If only health policy were treated as a science instead of a business tool.”
William B. Grant, Sunlight, Nutrition and Health Research Center (SUNARC), San Francisco

In putting forth its report, the IOM has destroyed any credibility it might have had with those who conduct the science of vitamin D. The IOM has misled the public and placed itself on a level with those who, in the past, ignorantly told us to avoid sunlight exposure at all costs. If the public follows their recommendations we will return to the Dark Ages of health awareness; the report is an absurd suppression of critically important research.

Do serum levels of vitamin D correlate to reduced cancer risk or not?

--
The American Journal of Epidemiology just released several studies on vitamin D and cancer that concluded vitamin D levels were not correlated to several cancers; that is, higher levels of vitamin D did not correlate to lowered cancer rates.[1] The key to understanding this finding is that in each case, the levels were measured prior to the diagnoses of cancer. Prediagnostic measurements occur at one point in time and do not measure changes that occur between the measurement and the onset of the disease. If, after the moment of vitamin D measurement, habits of sunlight exposure or diet change, vitamin D levels can fluctuate considerably. I believe that Vitamin D levels at the time of diagnosis are much more indicative of the affects of vitamin D on the risk of disease, and my opinion is that optimal higher vitamin D levels that are maintained for long periods are much more likely to reduce disease risk. Dr. William Grant, in an email today, told me he believed …”serum 25(OH)D levels measured several years ago aren't a good indication of either lifetime 25(OH)D or recent 25(OH)D." 25(OH)D is the measurement labs use to assess serum levels of vitamin D.

A randomized controlled trial (RCT) that maintains similar supplementation amounts for a period of years could give a good indication of whether consistently higher vitamin D levels have a protective affect on cancers. Let’s suppose, for instance, that one group of randomly chosen women received a vitamin D supplement for four years and another group received a placebo during that same time. All of the women would be free of cancer when the study began. Then, at the end of four years, the women would be assessed for the number of cancers in each group, and it could be determined if the supplemented group fared better than the placebo group. This is known as a randomized, placebo-controlled interventional study, and is considered the “gold standard” of research. Obviously, if the vitamin D group fared far better than the placebo group, we could confidently state that consistently higher vitamin D levels over four years correlated strongly with reduced risk of cancer. But wait—we already have such a study. Lappe and colleagues already conducted the study described above and found that the vitamin D group had 60-77% lesser risk of all cancers, compared to the placebo group, after four years.[2] None of the studies published by the American Journal of Epidemiology were RCT’s. This is strong indication that the use of prediagnostic levels of vitamin D may not be of much value.

Also interesting is the fact that the authors of these papers mention that research shows sunlight exposure correlates to a rather impressive risk reduction in most of the cancers studied. There are two outstanding papers, one very recent, which demonstrate that relationship.[3] [4]
Based on what we have just discussed, it is possible that (1) regular sunlight exposure maintains consistently higher levels of vitamin D and results in reductions of cancer similar to those demonstrated in the research conducted by Lappe and colleagues, or (2) sunlight has positive influences of cancer beyond the production of vitamin D. My opinion is that the answer lies in a combination of both. We are beginning to see more research showing that in both cancer and multiple sclerosis, sunlight exposure may have its own anti-cancer benefits. Sunshine is, of course, the most natural way to produce vitamin D. Just be very careful not to sunburn.



[1] http://aje.oxfordjournals.org/papbyrecent.dtl
[2] Lappe, J. et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007;85:1586–91.
[3] Grant WB. Does solar ultraviolet irradiation affect cancer mortality rates in China? .Asian Pac J Cancer Prev 2007;8(2):236-42.
[4] Chen W, Clements M, Rahman B, Zhang S, Qiao Y, Armstrong BK. Relationship between cancer mortality/incidence and ambient ultraviolet B irradiance in China. Cancer Causes Control.2010 Jun 16. [Epub ahead of print]

Melanoma: Midsummer Night’s Dream or Vitamin D-Deficiency Nightmare?

One of the most interesting medical research papers to arrive in recent memory is a 2009 study reported in the British Journal of Dermatology entitled, “Melanoma epidemic: a midsummer night’s dream?” [1] In it the authors make the case that melanoma is not caused by sunlight, but rather by an increasing diagnosis of benign lesions as melanoma. In other words, small spots on the skin that are harmless, and that in the past would have been classified as benign, are now being called stage-one melanoma. The authors point out that new diagnoses of stage-one melanoma have increased dramatically over the past few years, but new diagnoses of stage-two, -three and -four melanomas have not increased at all.

Some have suggested that the lack of increase in the latter stages of Melanoma is due to quick removal of the type-one melanomas, which prevents their progression to full-blown cancers. However, the authors point out that those in the study with type-two, three and four melanomas had not been previously diagnosed with type-one, and therefore could not have been “saved” by removal of type-one; the advanced cases were new presentations--people who had not been previously diagnosed with any stage of melanoma.

The case of these dermatologists—that melanoma is a “midsummer night’s dream”—is compelling. Obviously, millions of people who had nothing more than harmless lesions have been diagnosed with melanoma and have had their lesions removed surgically.

The researchers ended their analysis with this statement: “These findings should lead to a reconsideration of the treatment of ‘early’ lesions, a search for better diagnostic methods to distinguish them from truly malignant melanomas, re-evaluation of the role of ultraviolet radiation and recommendations for protection from it, as well as the need for a new direction in the search for the cause of melanoma.”

I can only say “amen” to this conclusion. However, these are not the first dermatologists to question the “epidemic” of melanoma and deny that sunlight is the cause. Dr. Bernard Ackerman, a celebrated dermatologist, wrote a monograph of several hundred pages entitled, Sunlight and the “Epidemic’ of Melanoma, Myth on Myth, in which he made the same argument about the supposed melanoma epidemic being due to incorrect diagnoses.[2] Dr. Arthur Rhodes, another dermatologist, has also given examples of many people who have died with real melanoma that occurred on areas of the body that were never exposed to sunlight.[3] These unfortunate people, believing that the lesions they discovered could not be melanoma because there was no sun exposure, failed to get help until it was too late.

Meanwhile, the world becomes more and more deficient in vitamin D due to the efforts of the “sunscare” movement that would have us believe that sunlight, one of God’s greatest gifts to living beings, is public enemy number one. This has resulted in incredible rates of vitamin D deficiency which have further resulted in an increase in at least 18 major cancers including breast, prostate and colon cancers. It has also resulted in increasing rates of heart disease, infections including flu, autism, and numerous other maladies that I discuss and fully document in my book. Never has there been a greater fraud than the push to scare people out of the sun to avoid a disease—melanoma—that is not an epidemic at all, and whose risk is increased by sun avoidance. Non-burning sunlight exposure is absolutely necessary for optimal human health.

Not only is the “epidemic” of melanoma a midsummer night’s dream, it has become a vitamin D-deficiency nightmare.

[1] N.J. Levell, C.C. Beattie,* S. Shuster and D.C. Greenberg* Melanoma epidemic: a midsummer night’s dream? British Journal of Dermatology 2009;161:630–634
[2] Ackerman, A. Sun and the “Epidemic” of Melanoma, Myth on Myth. Ardor Scribendi, LTD, New York, 2008
[3] Rhodes, A. Guest editorial, Melanoma’s Public Message. Skin and Allergy News 2003;34:1-4

Living longer and better with Vitamin D and sunlight

Low vitamin D levels have once again proven to be a risk factor for earlier death. In a study of Asian women, low levels of vitamin D correlated to a doubling of the risk of death over 6.9 years.[1] Osteoporosis and cancer that existed when the study began were also predictive of early death, which would be expected. What intrigues me is that both osteoporosis and cancer are closely correlated to low vitamin D levels; it is therefore plausible that low levels of vitamin D were not only directly responsible for a higher death rate, but also at least partially responsible for the increased risk of the two deadly diseases that also predicted more deaths.

This is at least the third study to show that lower vitamin D levels correlate to shortened life spans. The evidence is incontrovertible: for a long life with fewer diseases, keep your vitamin D levels high.

[1] Kuroda, T et al. Contributions of 25-hydroxyvitamin D, co-morbidities and bone mass to mortality in Japanese postmenopausal women. Bone 2009;44:168–172

How much vitamin D do you need to reduce risk of cancer, osteoporosis, heart disease, gum disease, diabetes, hypertension, etc.?

My book cites research from over 800 medical/scientific journals research that consistently demonstrates a direct correlation between vitamin D deficiency and more than one hundred diseases and disorders. Only those whose heads are buried in the sand could believe that optimal levels of D are not necessary for excellent health. However, along with vitamin D’s newfound popularity, there is bewilderment about what is “optimal.”

What is the optimal level of vitamin D?

Dr. Bruce Hollis and his colleagues conducted research in which they determined that no circulating vitamin D3 can be measured in the blood until 25(OH)D levels are greater than 40-50 ng/ml.[1] This means that all vitamin D3 is used by the tissues to make 25(OH)D until the level is greater than 40-50. At that point, vitamin D3 begins to be measurable, meaning that the tissues are no longer so “hungry” for D3 that they use up every molecule made by the skin or taken orally. Therefore, optimal levels are probably somewhere over 50. Dr. John Cannell and I, in researching our book on vitamin D and athletics, found that athletic performance improves up to about 50-60 ng/ml and declines slightly at higher levels. In addition, a recent study showed that those with high vitamin D levels lived 26% longer than those with low levels; however, beyond 50 ng/ml, higher levels did not confer further advantage.[2]

How much vitamin D does it take to produce the optimal level of 50-60?

Each intake of 100 IU per day of supplementation raises the blood levels of vitamin D about 1 ng/ml. Therefore, if there were no sun exposure or a source of dietary vitamin D, it would require 5,000 IU of supplemental D3 per day to achieve a level of 50. This rule of thumb, of course, varies according to the size of the person; a large person will require more vitamin D than a small person. It is also interesting to note that men who have high levels of vitamin D (due to outdoor summer activity) must take 5,000 IU during winter to maintain those levels.[3]
A special case: nursing mothers

Nursing mothers must furnish sufficient vitamin D3 for themselves and their babies; if they are deficient, the babies have a greater risk of autism, schizophrenia and osteoporosis as they grow older. Dr. Hollis and his colleagues have demonstrated that nursing women need at least 6,400 IU per day to maintain adequate levels of 25(OH)D in both mother and child.[4]

Remember that in Caucasian skin, twenty minutes of full-body sunlight exposure (both sides) will produce from 10,000-20,000 IU of vitamin D. A good tanning bed will produce about 10,000 IU in ten minutes. In either case, be sure not to burn.

Hopefully, this information has reduced any confusion about optimal levels of vitamin D and how to maintain them. Get those levels up to 50-60 ng/ml!

[1] Hollis, B. et al. Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans: An Important Tool to Define Adequate Nutritional Vitamin D Status. J Steroid Biochem Mol Biol. 2007 March; 103(3-5): 631–634.
[2] Melamed, M. et al. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med. 2008 Aug 11;168(15):1629-37.
[3] Heaney, R. et al. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003;77:204-10.
[4]Wagner C. et al. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med. 2006;1:59-70.